Interruptions.....

I stopped to visit a friend in the hospital and had a chance to observe some clinical workflow in person.  The Nurse walked in.  She had a large brick of a phone wrapped in a plastic case pulling the side of her scrubs uncomfortably down.   She began asking questions as she prepared the medications.  She reached into her pocket and pulled out an Iphone……confusing…..then I realized it was her medication scanner.

As she was preparing to hand the medications to my friend the brick rang…..loud….very loud…. She apologized as she reached down and complained that the previous shift must have had the ringer turned up. (I was there at 8am in the morning so evidently night shift likes to carry a mobile alarm clock) She silenced it and went back to medication work.  I asked “Do you like your phone” – she held up her iphone and said “This isn’t used as a phone it’s just for meds and stuff.” I laughed and smiled “No the brick wrapped in bubble wrap hooked to your scrubs.”  She laughed and said “No Comment” as she finished putting the medication in the cup and talking to Holly she looked at me and said “That thing interrupts me when I am trying to work with a patient and it’s just rude to the patient. I don’t think it’s very practical…..I like to be fully engaged when I am with a patient”

Ouch…every technologist who has designed a decentralized workflow should wince when they hear that – this nurse is a young lady who grew up with a cell phone in her hand wanted to be what? “fully engaged with her patient”  She wanted to walk into a patient’s room and only think about what she needs to do in that moment.  She wanted to focus on getting my friends medications accurate, make sure she didn’t miss any aspect that could be a warning sign…..crazy thing….she wanted to be a nurse.

As I worked on this post – I started writing about ideas for fixing….pointing out that holding on to old technology only hurts your facility….listening to nursing because they actually do the work….blah blah blah…..but then I started think this isn’t just a hospital thing.

I was sitting in my family room – Noah (aka #4) on my lap talking about his day and my phone rang…..in that moment I stopped engaging with Noah and answered my phone…I tried to justify in my mind that I had tried to get ahold of this person all day and needed the information….as I hung up Noah said “Mom, can you just talk to me for a minute”….ouch…. As I began writing this blog for “Linkedin Content” to promote my industry knowledge…..I am pausing for a moment.

Our workflow design reflects our society design….the nurses response is reflecting the shift in our society to tolerate interruptions.   She recognizes that everyone would like a bit of undivided attention, especially when they are in a new environment.  She recognizes that the technology she had been given was not serving her well and was making her less effective in her job.  She recognizes that – just like Noah – her focus on my friend in that moment should be the most important part of her day.

So this post should serve two purposes – rethink how you are designing your clinical workflow and alarm design.  Clinicians are fatigued because their attention is constantly being split.  Clinicians are fatigued because we, as technologist, aren’t doing our jobs.

The second purpose – does your personal life reflect an interrupt driven society? When will that become not ok for you?

Last night…..I left my phablet in the kitchen….turned the ringer off….and enjoyed my family and some friends.  It was probably the best night I have had in months…..today…..the ringer is still turned off.

Zig would be Proud

When I was a kid, my Dad had a thing for Zig Ziglar.  We had videos, cassette tapes, scheduled listening times, and lots of conversations.  Dad would say “If you don’t know where you are going – you won’t know when you get there.” Coming from a man who I saw as remarkably successful, I was intent on learning his secret.   

He wrote his goals down – he made them attainable, measurable, and part of his overall strategy. I never had a problem writing down my goals….I found a notebook a while back from 1993 (you can guess my age later) and I had 10 goals written down, even a plan to obtain each of them.  The problem I have had since 1993, and even still today, is measuring along the plan consistently.  Generally, my measurements are done on a schedule, but often take several hours to collect information or run a report.

It’s interesting when you are running a growing organization how measuring consistently sometimes escape us in the hustle of things – new version releases, launches, growing customer lists, etc.  It’s more fun to think of new software features based on the latest customer feedback then to focus on the “details”.   As a small company – the devil is in the details…..as we have gotten “bigger”….we have found the devil is still in those details. 

Setting and managing goals is more than measuring the end result, it’s about measuring along the process, measuring each individuals contribution…….and doing it in an efficient way. 

On February 11^th,  Sphere3 will be releasing a new tool for our clients called myMetrics™ this tool measures individuals progress in specific categories using not only patient feedback from our Leadership Rouding tool but real metrics of actives from your call light system.  It gives the caregiver an understanding of how their efforts play into the whole strategy of improving HCAHPS.

·         What is the individual’s ability to respond – whether they are the first person to get the call or the third?  

·         What is the individuals visit rate – how often does this individual go to the patient room whether beckoned or not?

·         How does the patient perceive the care they are receiving?

HCAHPS is a balance between perception and actual execution of task.  Goals of perception mean nothing if you don’t have a quantifiable balance point – a benchmark on the task associated with achieving that goal.  A quantifiable balance point means nothing unless it can truly be applied to an individual’s performance.  

Here are some thoughts as you enter the new year:

1)      A paper or “report” based process to manage these items won’t cut it – you will spend more on the resources to pull the data then you would having a tool to do it for you “auto-magically”.

2)      Caregivers (any employee) needs a concise view of their contribution to the overall vision and strategy of the organization. 

3)      Your job as a manager should be coaching them to improvement not compiling data, and creating a report.

Define the Strike Zone

As a working mom with 4 boys juggling soccer practices, games, school events, and career can be really a challenge….but it’s what I signed up for when I took on this CEO role.  A few months ago, I was fortunate enough to get done early with a meeting in and grab a flight home to make it too Tucker’s baseball game.  I was glad I made it, because there was a great learning moment…..

Tucker (aka #2) stepped up on the mound and took his first warm up pitch….zip! It flew right over the catchers head and smashed into the fence causing the parents to jump.  He shook his head….frustrated….and quickly he took his next pitch…..ZIP! This time harder.   Still over the catchers head.  A mother behind me exclaimed “Someone needs to tell that boy not to throw so hard or he might injure someone.”  I bit my tongue, my response would have been “Lady wrap your kid in bubble wrap and let’s play ball.”  Instead I stood up and walked over to the fence saying “bring it down Tuck” and the mom whispered her remaining comments to her friend. 

If the other team didn’t have such an affinity to swing at high outside balls, then it would’ve been a looong inning.  The umpire held true to the strike zone so every batter went to a full count.  Fortunately, the young batters just liked to swing the bat so the inning ended quickly.  He headed to the dug out – head hung low – and sat down. 

I walked over to check on him “Hey Wild Thing are you ok?” (He didn’t understand the movie reference, but it made me smile)

“My pitches were high.”
“It happens…. sometimes we make mistakes – just bring your pitches down.  He was calling a generous strike zone -”
“But mom, it’s not my fault!” Tucker interrupted me “I didn’t expect to pitch tonight, my Dad wasn’t here to warm me up, and the coach made me clean up someone else’s mess.” 
My eye brows raised….for those of you that don’t speak Kourtney my eyebrows are my “tell” (I will never be able to play poker)… “Excuse me – whose hand did the ball leave? Who threw the pitches?”
 “Me….but”
“Tucker, you threw the pitches – you are responsible for the result.  It’s not enough just to get it over the plate – it has to be in the strike zone.  Now quit complaining and get ready for the next inning.”

Every Pitcher knows that his goal is to throw the ball over the plate in a way that the batter will swing at it (and hopefully not make contact).   It’s a universal understanding for baseball.  The umpire provides the detail on what and where he should focus – the umpire sets the actual strike zone. 

In the same way, every hospital knows that their strategic goal is to have satisfied patients, satisfied employees, and provide quality service….this has been the edict for years.  (Those goals should be the same for every business)  HCAHPS are not a new or revolutionary understanding of providing care that satisfies the needs of the patients.  HCAHPS simply defines the strike zone.  Instead of the general idea of throwing the ball over the plate – we must have “satisfied” customers – HCAHPS provides categories and expectations.  (We can all debate the validity of using “always” but that’s a blog for another time.)

Additionally, HCAHPS defines personal responsibility for our employees and a structure to hold them accountable for those actions.   Tucker threw his pitches high and outside – he was responsible for the every pitch he threw – good or bad.  He had the best intentions to throw a strike, but when the pitch left his hand….it was off the mark.  As his quasi coach that night, I was able to observe be outside the interaction from outside the field.  When he got to the dugout, I provided instruction based on his actions….in essence at the “point of care” I was able to instruct him on his next action.  In the weeks that followed, he pitched to me in the front yard and I could coach him based on his need.  (Did I mention I was a catcher for 10+years…poor kid)

As leaders in our organization it is important to engage during the work day – providing insight into how our team can improve what they are doing based on our outside perspective.   It’s critical that we create coaching moments outside of the heat of battle based on the information collected….Tucker throws a lot of high pitches.  I observed his grip, release, and stance during the game and was able to coach him in the front yard towards a better pitch.  You as leaders need information about how your employees serve your clients - defining not only what your expectation is but what your clients expectation is to find ways to continuously improve.   

 

Are you coaching your team to a better result? 

Do you have the information to be able to do so? 

Do you know what your patients except and are you meeting those expectations? 

Are you depending on post discharge data where the patients view of care has "settled" from the actual experience?

Are you comparing their feedback with the actual to define benchmarks? or do you set arbitrary benchmarks based on your gut feel?

How are you daily engaging at the point of care - gathering data, providing information, and creating coaching moments?

 

Compiling and Comparing Data

I work at a lot of coffee shops.  It’s not that we don’t have an office but there is something about being in a space with music, coffee, and energy.    There are always people there meeting for business – to stop collaborate and listen.   I have done it dozens of times myself – reached out to people who have expertise in a specific area or have started a business and can give insight from a been there, done that perspective.   This blog is spattered with some of those stories.

My one regret is how I have managed all the information that I have gathered in the last few years.  I take really crazy notes mostly with doodles and pictures.  When people say a picture speaks a thousand words- they are right (plus it’s easier to remember a picture).  The team jokes I have an addiction to spiral notebooks, there are about 50 in my office full of “valuable” information.   While I have gotten better about giving the algorithms to Kristal to be properly documented for evaluation, testing, and roadmapping  – there is a lot of information that is not that square – not a number, not an equation, more anecdotal but still important.   Those feelings that are just as important as a data point. 

I once had a friend describe working for a startup and watching the CEO of that company change in the years of its build.  The story itself was not uncommon to many I have heard before, but for some reason his words describing his perception of the emotional state of the CEO were.  Perception of the event or process – feelings – are as important as hard data.

We are working on ways to capture those thoughts of caregivers and nurses so that the square data can be compared to squiggly line data – thoughts, impressions, and ideas.  Active comparison to perception vs the reality of a situation will help to create more accurate benchmarks….just because you can be staffed to have a 10 second response time….is it necessary?  That was a hard question for me – my gut says YES of course if we can and we should but reality is there is always a cost associated with the movement.  I almost hate to say it but in this dynamically changing industry…. Is that worth the cost….

The balance between delivering the hospital leadership perception of service excellence and delivering an “Always” can be two different things. 

The “Always” can be more accurately attained if you understand the reality of the perception of the patient – if you create an expectation and meet it.  The “Always” cannot be obtained when we set unreasonable expectations with our patients, or we fail to meet a basic level of expectation.

Best Coffee Shops in KC for Working....

Mildreds in The CrossRoads District
Roasterie in Brookside
Latte Land in Briar Cliff

Haven't found any I love out South so open to suggestions....

The Fire Sale

 If you have been listening in the last 2 weeks you know the nurse call industry is in a flutter….to say the least. A price war has ensued with what appeared to be slashing like I haven’t experienced prior. My phone has been ringing a lot…..a lot is kind of an understatement. I would think that it’s a competitive thing but in actuality it may be a fire sale which has caused a ripple effect throughout the industry.

 

A few months ago I wrote about GE being acquired by Ascom. Call me crazy but when a manufacture of telecom handsets purchases a nurse call system then cuts the price significantly does it signal more than just we want to take market share? To call their pricing strategy “creative” would also be an understatement.  I am not suggesting "trouble" by any means - I am suggesting a strategic change in approach to market AND possibility that a new nurse call - one which lines up closer to their UNITE product may be in the works.  Possibly there is a need to make some sales to secure the client and move them to a new platform when it's released.   

To remain competitive it appears that the other others are indeed re-evaluating their strategies – essentially relying on the value in their hardware to secure their place.   In my opinion (humble as it may be) Nurse Call has spent the last 3 years trying to prove their overreaching “workflow” value in the market place only to play the games of a contractor today.   I am not trying to pick on GE by any means - they are just making the biggest change.

So what does this mean? Is it a signal in the market place of the devaluation of nurse call? Remids me of the blog I wrote a few years ago about Electronic Life, Technology Life and Workflow Ability. (I wrote a little algorithm to help hospitals understand this by answering a few questions and scoring the results per unit – helps phase installs – if you are planning an upgrade - give us a call.)

I don't think it's a devaluation - I believe the shift has started in redefining Nurse Call to a more patient centric cloud based product.

Stay Tuned - I will post some tips for hospitals making the decision on new nurse call.

Cerner Health Conference

Living here in Kansas City everyone “knows” or more accurately claims to know something about Neal Patterson.  As the iconic entrepreneur walked by my second row seat and took the stage for his Keynote at the Cerner Health Conference,  I wasn’t sure what to expect.    I tried to brush aside all the good and bad I’ve heard and just listen to see if I could connect to him and Cerner.  

I expected a politician – slick with perfectly constructed and managed content.  A more accurate description is comfortable, confident and owning the content.   Dressed casually, he appeared more approachable than intimidating. His speech style was more conversational than choreographed.  The “picture in his head” is much more detailed than what he could share in the time frame.   He was funny and entertaining – much more than I expected.  I take time to describe him because when you read about what he said I want you to see this picture of him.   These are sound bites with my interpretation. 

“We must separate Health and Care”
Cerner, throughout the conference, delivered the next frontier of their ambitious goals: Managing health as opposed to maintaining a sick society.   The Solutions Gallery Floor was split into three areas Foundation, Organizational Excellence, and Community.  When you entered the solutions gallery floor the first thing you see is Foundation.  Many times when I have talked to people about being able to interpret data we have to step back and look at the way it’s collected and the model in which it is stored.  The Foundation is representing the “Care”.  How hospitals document and gather the information that improves the care of the patient.   Though the pods were a little fragmented and hard to see the vision of how they all played together the message was one foundational platform to collect data.

If you think about the future of care it’s built on the foundation of data.  Think of it this way – if you build your house on sand there is no way to maintain the stability of the structure.  If you build your house on a solid foundation then expansion and stability are givens.

Across from Foundation is the next frontier the “Health” what Cerner noted as Community.  I thought the visual was quite nice – the past was facing the future.   We MUST start managing the wellness the health of not only an individual but of entire populations. 

“What Steve Jobs did in regards to music – Cerner is doing with health data”

I found this statement extremely bold, but accurate. The challenge with most leaders is to be able to drive vision, growth and domination in an industry you are often seen as prideful.  While I agree with some of the pundits – a self comparison to the actions of Apple, the benchmark for transformational innovation, is not the most humble of statements – the only thing I would throw back – isn’t it pretty accurate?   Cliff and Neal took the documentation of processes and have systematically transformed it into a billable standard. And amazingly have driven such change into the industry that the government has seen the benefits of this documentation and will now subsidize their growth through mandates to their core customers.

The thing I would challenge Cerner on is this – Apple has the unique ability to take a complex idea and make it simple to use, visually appealing, and extremely easy to understand.  On the BI side - I didn’t quite see that in Cerner yet – not saying they won’t get there.   They have built a firm foundation – collection and storage of data.  The hard part is the presentation of the data in a useable manageable format. 

The center of their Solutions Gallery was the Organizational Excellence.   I stopped in to see their dashboards and examine their process.   My take away and I hope this isn’t too harsh – they are just not there yet….a little bland and canned.   My encouragement to them – the people who will be successful in the BI space are those who can take the data and do what Neal told the audience Cerner will do “We will future proof your organization” he said that in regards to how the government will change reimbursement based on the collected data.   Somehow you have to take your incredibly complex data set and deliver it to leaders in the hospital in useable fashion.   Most people are not data junkies.

I will say this as a note to the other EMR companies – my money is on Cerner to do this first and from being first they will build the standard.  If you are not all ready in the space you are all ready behind and if you are looking at only the EMR data set – you won't catch them.

The final two statements hit home for me and if you listened to what Neal Patterson was saying they were actually quite revealing to who he is as a person.  

“We are all mortal with a huge instinct to survive.”

There is an underlying ambition to extend life and improve the quality of life.  While not the most personable way to put this thought to the audience – it was a directive.   From a technical standpoint this is the push to build PHR and build it well.  Driving home the point that we must manage health creating a foundational platform like Cerner has done in the “Care” space for the “health” space.  Fixing PHR.  

 “If we know something and we know how to predict it in the future why aren’t we doing it?”

I am not sure if the crowd heard it, but I heard frustration in this statement.   When you hold great power, knowledge, data……when you can see the future and you are pulling those around you to understand it…..when your mind understands that all the pieces of the puzzle are there and all we have to do is put them together….. it’s almost excruciating.  It’s a blessing and a curse to have a vision. 

When that type of driving vision is mixed with a personal experience it intensifies in a way that many won’t understand.  Neal’s top 4 things he wanted to accomplish in this decade – one was “Save Linda’s Life”.    Linda, his sister in law, died from Sepsis.    Can you imagine being one of the most powerful people in healthcare and losing a loved one to a preventable medical error?   Knowing that the data contained in your servers holds a key to change possibly annihilate this and other preventable medical errors?   With great understanding, knowledge, and blessing comes great responsibility - great responsibility engages great pressure.

In closing - Cerner is not Disney World – not what I would describe as “friendly” place but they are knowledgeable and they are incredibly capable and powerful.  They will find answers and save lives.   I am not sold on them as an organization, but after this speech I do see that the leader has passion and purpose.  

How to Define "Help"?

When you order BBQ in Kansas City – you don’t just order burnt ends – you can order chopped burnt end sandwiches which can be sauced or dry – you can order a platter which can be sauced or dry – you can order it as a combo. Then there are the side dish selections…cheesy corn, beans, slaw, pickles….

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?”

The interesting thing about the next section of the question is its tie to “help”.   What defines help?  In most hospitals if you press the “call button” there is one “button” it’s big and it’s red. You can figure out it’s for “help” even when you are groggy or sick. The newest fad is to add more buttons – which is great for me would work. I am used to self selecting. I self-check at the airport, I order meals and movies on my Iphone, and think nothing of the lack of real “service” that is providing.

My mom (who is 62) would think the extra buttons were a novelty. She would laugh as she tried to find her glasses to read the small words on the extra buttons “water, pain, or toilet” then ask me if she pressed toilet does that mean she has to go or that she went. She would never press the pain button because she rarely admits when she is in pain.  She would always press the red button.  (Please no hate mail here, I am generalized a generation based on my experience with my parents)

My grandma would press no buttons….even with her glasses she probably couldn’t read those little words, and she would look at the crazy “paddle” and say why are there so many buttons. Then she would look at me and say “Bo, go get my nurse” I would either press her big red button or I would just walk out of the room to find the nurse.

The point is defining “help” is challenging in a healthcare environment especially in a patient self-directed self-selection process. Evaluating “help” is even more challenging. There are numerous options and building the paddle would be a challenge. Ironically, in an industry move to be more efficient and direct patients needs to a caregiver using a decentralized design method – we lost a great deal of the data modeling. There is no way to track the request specifics in an automated fashion in a decentralized design without additional manual steps (which frankly defeats the purpose). There is no way to get specifics but there are request patterns.

There are ways to collect this request data – get a good understanding – then design you call processes. Just to take it a step further – we can tell you how many of each type of request hit when, how many were answered in your desired time frame (or what your average time frame), and even how the caregiver interacted with the request. If there is a hospital interested in knowing how to create a real patient centric care model – call us – we are looking for partners in a study to make life better.

The current analysis structure (at least what we have found published) looks at qualitative information – how many focus groups does it take to get to water, pain, and toilet? What’s crazy is all the information you could want to design the paddle or better the process is locked inside the nurse call system….if the hospital has a reporting package because most nurse call systems are built like archaic life safety tools with proprietary databases.

What’s more – I am the patient – I want to know how quickly you responded to my need – I know the information is there and frankly I know how to get to it. Stop and think how valuable that could be though - if I am going to do a survey (qualitative) to evaluate my care would it be better if I knew on average you answered my call light within 30 seconds every time PRIOR to me filling out the survey. Sometimes it feels like longer – but when you KNOW what the time is aren’t you more patient….Do you think that would influence my decision on whether or not I had good care?

But what do I know…. I am just a mom who had a sick baby and instead of blasting a hospital for a bad experience – I dug down to figure out how to solve for a pain I felt during a hospital stay.  It really is that simple….by the way so is the data.

"The Immediacy Conundrum"

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button.


“after you pressed the call button”

Patience is not in abundant supply at Gate’s BBQ. When you walk in the door they shout at you - “Hi May I help you?” you must know to yell back very quickly – there is no patience for Umm or questions – by either the counter staff or the patrons behind you. You must shout back – quickly with full confidence - “Yes, I want a burnt end sandwich, fries, and a Ice Tea.” The food arrives to the counter very quickly – you can watch the man through the cook window constantly chopping and slicing meat to serve – you know it will be good, hot, and fresh.

The Gates atmosphere creates an expectation for an immediate response to questions, there must be no hesitation. I have reviewed reams of data from nurse call systems and 4 years ago when we started – the average wait time before exit of the bed for a patient was about 1:13. Now we see a majority falling under the 30 second threshold. Are people getting more impatient? Maybe…

We live in a world where as soon as I want to be connected my expectation is to have connection. The problem with “after you pressed the call button” is many patients expectation is immediate. Geeky techy stuff – if you have a nurse call system older than 2 years and you are functioning in decentralized – there is a lag time. Depending on the specific system – it can be an “eternity” in terms of immediacy. This is not a reflection on caregivers, it may actually be a reflection on the implementation of technology. Yet, caregivers are under pressure. Just like Gates, the health system and government is creating an atmosphere around hospitals that require immediacy. By its ever- more acute care criteria for entry, there is an equal expectation for immediate response?

Let’s talk solutions to the immediacy conundrum. The Decentralized Nurse Call craze of a few years ago is beginning to subside as hospitals realize the limitations of moving the patient call to an individual who is mobile and has variable task responsibilities on the unit. Decentralizing or sending the “Normal” patient call to a wireless device does not solve for immediacy – it’s actually the most difficult methodology for nursing to utilize because there is no immediate feedback on volume of requests or the “queue”. Immediacy requires the “queue” to be low and the person answering the call to interact and disconnect quickly. Think Economics - Basic Supply and Demand Theory – if you have too many nurses and not enough calls then you are fine. However, what is generally the case at documentable specific periods of shifts, if you have too many calls and not enough staff then you are going to get low scores on question 4.

The trick is the patient has a need and since they are not in their home environment and have very little control of their surroundings – many “wants” become needs. Not to mention the variation in expectation. The patient requires an immediate interaction – not an immediate solution. This is a really important point – so don’t miss it – the patient needs an immediate interaction and a sense that their need has been identified and help is on the way. The second key to this is you must deliver on the promise. So, if you have pushed your button and someone has quickly told you “help is on the way” then help must really be on the way. The only way to manage that is to develop a methodology to alert the needed caregiver with a specific request – data rich. Then Mobilize AND Monitor their action towards delivery. What does this mean – the person interacting with the patients request should be air traffic control – they should be able to monitor the total quantity of requests and estimate a delivery time. If there is a change in delivery time – maybe the patient should even be notified…..

BBQ and Nurse Call

I have noticed that several of my blog posts involve food…diets…etc It’s a true statement that one of my vices is really good food – not pretentiously good food – just plain good food. My pallet is not well refined, but I know when something tastes good and when I am served well.



One of my favorite restaurants is Jack Stack BBQ. Disclaimer: I live in Kansas City and talking BBQ is similar to talking about religion. There are alliances to BBQ that span generations of families. So, to be fair let me list the other greats in the Kansas City: 1)Gates – where “HI MAY I HELP YOU” is shouted at you when you walk in the door, 2) Arthur Bryants - where sweat is integral to experiencing the meal, and 3) Oklahoma Joes - only loses points because of the name.


According to the Kansas City BBQ Society (http://www.kcbs.us/ ), Carolyn Wells Ph. B, tells me it is measured on Appearance, Taste, and Tenderness. To achieve success in competition you must have quality in 5 areas: cooking unit, meat, seasoning, fuel, and most elusive, expertise of the chef.


For those of us with the untrained tongue, the challenge with BBQ is all data to assess are qualitative judgment’s – meaning, based on how I feel at that very moment I have made a judgment call on its goodness. Don’t get me wrong - when you taste a crispy chopped burnt end sandwich with just the right amount of salt, spicy sauce, and for me Cole Slaw on top, you will know what heaven will be like and I challenge anyone to say it’s not good.


So, what does BBQ have to do with Nurse Call? I look at Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button. I think would I ever answer "Always"?

One of the most concerning aspects of healthcare is measuring qualitative – questions based on “feelings” without creating a reasonable expectation for delivery. For example, asking “Did Jack Stack taste good?” to a random selection of people. (I have heard you East Coast folks think you know BBQ.) My perception of good BBQ is different than a person who prefers Memphis “Dry” BBQ , a North Carolina Vinegar based BBQ, and Texas hunk of meat they call BBQ.


In the next few blog posts I plan to break down question #4 and dig through how we can really expect to build continuous improvement and value from a “feelings” based survey question. How hospitals can use data that is existing in their facility to create quantitative Inidications of Care or what we call IndiCares™.


Just to get you started:


“During your hospital stay” this is a variable length of time. A metric based on an inconsistent variable is not easily understood and does not lend itself to being fixed. The time frame “your hospital stay” could be 1 day, 2 days, 1 week, or in a rare situation 1 month. The variable also could be a “frequent flier” as my favorite Children’s hospital calls their recurrent patients vs a one time in five years visitor. Their time may be short and consistent or random and long. 

We have evaluated data from over 30,000 patient days and the interesting thing about the data it is until you break it down by specific consistent measures there are very few patterns.  You have to stop looking at the data as Spaghetti and create a waffle structure.


A parting thought - If the data is barcoded according to which patient submitted it – why not just look at their nurse call statistics after their stay in comparison to their responses? If you are a hospital and don't know how to do that - call me or email me - I will tell you how to get to your data.